The Trump Administration’s budget proposal released yesterday is an affront to women and families nationwide. It targets abortion providers like Maine Family Planning by prohibiting any Health and Human Services funding, including Medicaid and family planning funding, from going to any clinic or health care facility that also offers abortion services. While the move is unsurprising, it is no less unsettling. This is an ideological attack that, if implemented, will only erect additional barriers to health care for poor, low-income, and vulnerable people.

Last weekend, 12 dedicated women joined Maine Family Planning staff for the inaugural, intensive Fighting Forward Abortion Advocacy Training. While hundreds of Mainers participated in anniversary Women’s Marches and related events, our spirit of resistance to attacks on reproductive rights took a less visible but equally important form. The impetus for the training was a desire to honor 45 years since Roe v. Wade made abortion legal in the United States, while addressing the stubborn existence of social, medical, and political stigma that pushes meaningful access to abortion out of reach for too many. After an intensive year of ongoing mobilization and passionate lobbying of elected officials—something that is new for many and familiar to others—there are Mainers who are ready to deepen their skill sets and diversify tactics. We recognize that even though a majority of Americans support abortion rights in most instances, mystification remains about the procedure itself, the realities of access, and how to deeply engage with others about a topic so shrouded in stigma.

Fighting Forward set out to demystify the clinical procedure and marry this new understanding with exercises that foreground values-based conversations supported by data from reputable sources. Our inaugural class jumped right in, sharing their most pressing questions and the rhetoric they’ve found most difficult to engage, as well as how their personal values and views around abortion may have shifted over time. This inspiring, inter-generational group of women, who hailed from communities including Fairfield, Portland, Belfast, and Orono, modeled how to bring the raging spirit of a march to the quiet, daily conversations that shift our language, thinking, and actions away from stigma and toward a world where rights to bodily autonomy and self-determination are actualized. We couldn’t be more proud to play a role in helping champions of reproductive rights find their voices.

Saturday was just the first of several trainings Maine Family Planning staff will complete this year with cohorts across the state. Our goal is to foster a statewide network of informed, skilled, and confident abortion rights advocates who are prepared to instigate culture shifts and push for significant legislative victories on reproductive rights. Following this first session, we can already feel how much more powerful our passion becomes when we make investments in each other’s’ leadership and channel our energies effectively. We’re digging in for the long haul, and we can’t wait for you to join us!

There are at least seven CPCs spread throughout Maine. For the most part, they operate as the roughly 3,000 CPCs nationwide do: by spreading misinformation, sowing unnecessary fear, and perpetuating stigmas around abortion, birth control, and sex. Furthermore, as Hannah Ruhlin recently wrote at the Maine Beacon, “CPCs often lie about the realities of abortion clinics, painting them as cold places where abortion is the only option.”

What we know, of course, is that abortion care providers like Maine Family Planning offer a wide range of comprehensive reproductive health care services, and that our expert clinicians are anything but cold; they offer compassionate and non-judgmental care to anyone who walks through the door.

Several states and municipalities have attempted to regulate CPCs by requiring them to disclose what they are (and what they are not, namely: medical facilities) and to fully inform women about their options regarding abortion, birth control, and prenatal care.

One of those states is California, with its Reproductive FACT Act—and that’s what the US Supreme Court will be looking at this spring.

[T]he justices agreed to weigh in on a challenge by “crisis pregnancy centers” – nonprofits that try to steer pregnant women away from having abortions – to a California law that requires the centers to convey specific messages. The law mandates that nonprofits that are licensed to provide medical services post notices to inform their patients that free or low-cost abortions are available and to provide the telephone number of the state agency that can put the patients in touch with providers of those abortions. The groups that are not licensed to provide medical services – but try to support pregnant women by supplying them with diapers and formula, for example – must include disclaimers in their advertisements to make clear – in up to 13 languages – that their services do not include medical help.

The nonprofits went to court, arguing that California’s law violates the First Amendment, both by requiring them to convey the messages and, because the requirements do not apply to clinics that perform abortions, by targeting them because they discourage women from seeking abortions. A federal district court rejected their arguments, and the U.S. Court of Appeals for the 9th Circuit affirmed. The nonprofits went to the Supreme Court last spring, hoping that it would agree to rule on their case. After asking the lower court to send the record in the case – a sure sign that at least one justice is looking at the case closely — today the court granted review to decide whether the disclosures required by the California law violate the First Amendment’s free speech clause; it declined to decide whether the disclosures run afoul of another part of the First Amendment that bars the government from prohibiting the free exercise of religion.

Oral arguments have not yet been scheduled. This will be the first abortion-related case with Justice Neil Gorsuch on the bench.

Back in November, Ilyse Hogue, president of NARAL Pro-Choice America, said the decision (likely to come down at the end of June) “could set the stage for how courts treat abortion rights for decades to come. As right-wing groups increasingly spread lies about abortion and basic reproductive health care, this case is an early test of whether the Supreme Court can guarantee our rights in the Trump era, including access to abortion care.”

Indeed, Media Matters abortion rights and reproductive health researcher Julie Tulbert warned at the end of December that we can expect a right-wing PR campaign on behalf of CPCs to “ramp up” in 2018.

“As the Supreme Court debates and decides NIFLA v. Becerra in 2018, the media should call out CPCs when they use deceptive tactics, and resist promoting the inevitable right-wing spin that free speech of such organizations is being unduly impeded,” Tulbert wrote.

Constitutional law scholar Robert A. Sedler explained in an op-ed just this week why, “[i]n my opinion, the California law does not violate the First Amendment. It doesn’t compel the clinics to say or not say anything, only to post truthful information provided by the state.”

“The Constitution enables the state to require that pregnant women seeking medical advice and assistance with their pregnancy have complete and accurate information so that they can make a fully informed choice,” wrote Sedler. “That is what this case is all about.”

Maine Family Planning will be watching and we’ll keep you updated as arguments are scheduled.

You may have heard that earlier this month, the Federal Communications Commission (FCC)—helmed by Trump appointee Ajit Pai—voted to gut the open internet principle known as Net Neutrality. This move is direct threat to women’s health, reproductive justice, and all movements that use the Internet to educate, organize, and fight back. But there’s still a chance to save the Internet as we know it.

Enacted in 2015, Net Neutrality prohibits internet service providers (ISPs) like AT&T, Comcast, and Verizon from speeding up, slowing down, or blocking any content, applications, or websites you want to use.

As such, “It preserves our right to communicate freely online,” says the advocacy group Free Press. “Net Neutrality means an internet that enables and protects free speech. It means that ISPs should provide us with open networks—and shouldn’t block or discriminate against any applications or content that ride over those networks. Just as your phone company shouldn’t decide who you call and what you say on that call, your ISP shouldn’t interfere with the content you view or post online.”

“Particularly damning is what today’s repeal will mean for marginalized groups, like communities of color, that rely on platforms like the internet to communicate, because traditional outlets do not consider their issues or concerns, worthy of any coverage,”wrote FCC commissioner Mignon Clyburn in her dissenting opinion to the December 14 vote.

And doing away with Net Neutrality could really hurt women, the reproductive justice movement, and anyone who needs the kind of reproductive health care services we provide here at Maine Family Planning.

“Without a free and open internet, anti-choice extremists could pay to block access to accurate information about reproductive health,” NARAL Pro-Choice America recently warned. “Imagine a world where a woman searches the internet but can find no information on how to access an abortion.”

Once upon a time, that might have sounded far-fetched. But given the Trump administration’s transparent war on women, it’s a future sadly worth considering…and girding against.

What’s more, the end of Net Neutrality could spell trouble for Maine Family Planning’s groundbreaking telemedicine services, which include abortion care. Loosening the reins on mega-telecom companies and allowing them to engage in something called “paid prioritization”—establishing “fast lanes” for sites that pay, and slow lanes for everyone else—would be bad news for rural patients who access health care services at home.

Those differing speeds could hurt telemedicine since it requires a “pretty robust connection,” said Mei Kwong, interim executive director and policy adviser for the Center for Connected Health Policy. “The last thing you want is for the interaction to suddenly freeze or the audio to go out or for the picture to be pixelated.”

Similarly, a panel of public health experts wrote in Health Affairs earlier this year:

Increasingly, telemedicine is being used to bring higher-end health care services to remote and rural areas to reduce health disparities. For telemedicine to be scalable and positively impact cost and outcomes, there must be a predictable infrastructure connecting patients, care providers, and technology. A prerequisite for telemedicine is broadband connectivity between telehealth sites. Reliable low cost service for telehealth is potentially threatened by the loss of [Net Neutrality or NN]. What happens to telehealth if Netflix traffic is preferred above medical applications? Could Internet Service Providers (ISPs) offer better services for one hospital system than another, helping them take over telehealth in a region? The undoing of NN weakens the infrastructure of reliable low cost connectivity that telehealth systems depend upon.

The American Academy of Pediatrics also declared in a letter to the FCC before the vote:

“AAP is opposed to the implementation of paid prioritization because of its detrimental effects on the elimination of health disparities, efficiency of healthcare, and access to health information by parents and caregiver. If healthcare providers do not have the financial resources necessary to purchase priority Internet access, they may not be able to provide the efficacious, patient-centered, cost effective care recommended as part of the ongoing transformation and reform of our nation’s healthcare system.”

Every day, Maine Family Planning works to increase health care access for rural and low-income women. Undoing Net Neutrality puts that access at risk.

A study published last week in the New England Journal of Medicine (NEJM) found a slightly elevated breast cancer risk among women who used low-dose hormonal birth control.

The roughly 20 percent increased risk of breast cancer—similar to the extra breast cancer risk contributed by physical inactivity, excessive weight gain in adulthood, or drinking an average of one or more alcoholic drinks per day—was found to be the same no matter what method of hormonal birth control was used.

When we spoke to Maine Family Planning medical experts, they said women and teens contemplating hormonal birth control (like the Pill, or long-acting reversible contraceptives/LARCs) should not be alarmed by the new research.

For one thing, this was an observational study and therefore it does not prove conclusively that hormonal contraception is definitely the cause of the increased risk—only that it may be a factor, just like female gender or advancing age.

As Aaron Carroll, professor of pediatrics at Indiana University School of Medicine, further explained in Sunday’s New York Times: “This was a prospective cohort study, meaning it was an observational study that followed women over time and saw what happened to them naturally. The data set didn’t allow for adjusting for some factors that could also be associated with breast cancer, like age at first menstruation; whether women breast-fed; whether they consumed alcohol and how much; whether they were physically active; and more. The study found only an association, and not causal proof you might obtain from a randomized controlled trial.”

For another, the increased risk documented by the researchers is still quite small, amounting to one additional case of breast cancer in every 1,500 women. And young women bear even less of the impact.

“The absolute increase in risk [found in the study] is 13 per 100,000 women overall, but only 2 per 100,000 women younger than 35 years of age,” wrote epidemiologist David Hunter, of the University of Oxford, in an editorial accompanying the study in NEJM.

Meanwhile, hormonal contraception continues to carry well documented benefits, including its efficacy in preventing unwanted pregnancy (which carries its own significant health issues), and substantial reductions in ovarian, endometrial, and colorectal cancers later in life. The New York Times spoke with a number of doctors who cautioned against reading too much into the research findings:

While the new study’s findings about breast cancer are important, “these results are not a cause for alarm,” said Dr. JoAnn E. Manson, a professor of women’s health at Harvard Medical School and chief of preventive medicine at Brigham and Women’s Hospital.

“It’s really problematic to look at one outcome in isolation. Hormonal contraception has a complex matrix of benefits and risks, and you need to look at the overall pattern.”

“When it comes to making your own personal health choices, you need to consider the entire set of benefits and risks,” said Kohar Der Simonian, MD, Medical Services Director for Maine Family Planning. “If you have concerns, the best thing to do is to bring them to your doctor or health care provider and find the solution that’s the right fit for you, as an individual.”

There are myriad ways this cruel legislation would hurt low-income and middle-class folks—all in the name of giving tax breaks to corporations and the wealthy—but we are particularly concerned by how the proposal could impact women and families. Not only does the bill cut key deductions that help Mainers make ends meet, but it tries to sneak in major policy changes that have nothing to do with “tax reform,” like gutting Obamacare and inserting anti-abortion language into an obscure provision on college savings. Bottom line: The tax bill is an abomination and it must be defeated.

From eliminating the student loan interest deduction and certain childcare credits to raising taxes on families that have serious and costly medical conditions, the “Tax Cuts and Jobs Act” includes many provisions that will make it harder for lower-income women and families to get by.Multiple analyses have shown that the tax plan’s biggest beneficiaries will be Wall Street titans and the super-rich, while middle- and lower-income households will see few, if any, benefits.

And then there’s the stealth attempt to repeal the Affordable Care Act’s (ACA) individual mandate through the tax bill. Putting aside that the some members of Congress just can’t seem to accept the fact that the American public doesn’t want Obamacare to go away, this is a dangerous proposal that would result in an estimated 13 million people losing their health coverage.

According to the Maine Center for Economic Policy, without the individual mandate, Mainers could see their premiums go up by as much as $3,000 in Maine’s more economically-depressed regions and the state’s uninsured rate would go up from 6.8 percent to 11.8 percent within 10 years.

When folks lose their health insurance, it puts more pressure on organizations like ours—Title X-funded health care providers who serve low-income, uninsured patients every day. When you consider that the Trump administration is simultaneously waging war against birth control affordability and family planning providers (not to mention the “anti-abortion Easter egg” tucked into the tax bill), you have a perfect storm with women’s health and autonomy in its eye.

Call Senator Collins TODAY and urge her to vote NO on the obscene tax bill. Urge her instead to support proposals that improve the health and well-being of Maine women and families. Together, we can make our voices heard.

Reproductive Justice Champions support a wide range of Maine Family Planning services and programs.

Tomorrow, November 28, is Giving Tuesday, a global day of giving that offers folks the opportunity to support their favorite charities amidst holiday shopping and deal-scoring bonanzas.

We hope you’ll participate in this altruistic activity by donating to Maine Family Planning. In particular, we urge you to consider our Reproductive Justice Champion monthly giving program. By committing to a monthly donation, you help us provide comprehensive reproductive health care to women, men, and teens across Maine. You help us empower teens to make healthy decisions through our Best Practices sexuality education curriculum. You help us advocate for your rights in Augusta, in Washington, D.C., and in courtrooms. You help transgender Mainers, rural Mainers, low-income Mainers… You get the picture.

And we need your support now more than ever. With a hostile administration in Washington, D.C., family planning providers like us have a target on our backs. From affordable birth control to abortion access, the Trump administration is waging a multi-pronged attack on women’s health care. Loyal friends like like you help us fight back.

Today is international Transgender Day of Remembrance, a day where we honor those whose lives were lost in acts of anti-transgender violence. According to the Human Rights Campaign, 2017 has already seen at least 25 transgender people fatally shot or killed by other violent means—and the vast majority were transgender people of color. “While the details of these cases differ, it is clear that fatal violence disproportionately affects transgender women of color, and that the intersections of racism, sexism, homophobia and transphobia conspire to deprive them of employment, housing, healthcare and other necessities, barriers that make them vulnerable,” HRC declares.

Maine Family Planning offers Open Door trans health services to folks at our clinics in Waterville and Lewiston, and statewide through our groundbreaking telemedicine technology. We are thrilled to also be on the cusp of expanding in-clinic services to additional locations in 2018. Soon, clinicians in Belfast, Bangor, and Fort Kent will also be able to offer trans health care on-site. This is an important deepening of our organizational commitment to reproductive justice. As Cazembe Murphy Jackson wrote today at Rewire: “It is so important for trans people to be included in the conversations about reproductive justice. ”

Jackson said:

We must reflect on our struggles and ensure that all of us have the ability to decide if, when, and how to become a parent, on our own terms. I believe this is at the core of reproductive justice: In order for any of us to have a taste of reproductive justice, it must be available to all of us. We must honor trans people as we are, while we are here, in every expression of our gender identity and reproduction. Honoring our resilience is resistance and remembrance.

To mark TDOR, Maine Family Planning nurse practitioners (NPs) Meredith Hunt and Sara Hayes—who manage the Open Door Program in Waterville and Lewiston, respectively—offered these reflections on the transgender health services they offer and their impact in Maine communities.

Meredith Hunt:

I really enjoy providing transhealth services. It feels good to have such a direct impact on improving people’s lives. I love when I can see the happiness in someone’s face when I say “Yeah, I can help you with that.” I also love that my patients in the Open Door Program really like coming in. Many of them have told me that it is the only medical appointment to which they look forward. I think what we are doing is so important and I see the impact in the community first hand. It is not just young people coming to see us. I have several patients who are over 50 and are so happy to finally have a place to go where they are accepted as who they truly are.

I will be attending the Transgender Day of Remembrance (TDOR) services in Waterville this year. I have attended the ceremonies in Portland in the past. When they read all the names of the transgender people who have lost their lives in the past year, I can’t help but get emotional. It is just so wrong and heartbreaking. I hope that by providing the services we offer, that we in some way are making the lives of transgender people in Maine better.

Sara Hayes:

I am very proud of our trans program at MFP. We currently have roughly 100 trans patients who Meredith and I are helping through this process and I absolutely love my trans practice.

Working with trans folk to get their inner and outer selves in balance is incredibly rewarding. Going through puberty as a teenager is especially rough for trans people and together we go through it again, but this time getting the hormones right. I love hearing about and seeing the physical changes my trans patients go through and their excitement is catching, for sure.

I’m also pretty excited that we are expanding the number of MFP NPs doing trans care. We have patients coming to us all over the state. Meredith and I can do visits via telehealth at any of our sites but I think it is important that we expand our on-site trans care options as well. Julie in Belfast has been getting up to speed and thanks to a MeHAF grant, we are getting Priscilla from Bangor and Christina from Fort Kent trained as well. My dream is that before too long, trans care is going to be available at all sites with any of our NPs.

Trans folk, especially trans women, have been the targets of violence and derision for forever. I have been doing trans care for almost 5 years and I hear from my patients that they are getting more support from their families and friends than trans folk have in the past. But for many, safety and support are not a given. The Transgender Day of Remembrance is not only a tribute to those who have tragically lost their lives because of other people’s hate and intolerance, but it is a reminder to all of us that we can’t be complacent about safety because unfortunately trans people are still and will continue to be targeted. Especially since the current administration in Washington is just adding fuel to sparks of intolerance and ignorance that will ignite into violence, not only against LGBT people. but also against minorities, women, and low-income people.

Here is a dispatch from intern Casey Rogers. Casey is a senior at the University of Maine, studying social work, and is spending this academic year as a field practicum student with Maine Family Planning.

Earlier this fall, I had the fortune of attending the Maine Women’s Summit on Economic Security. When I first read about the summit, I was excited for the opportunity to hear two amazing women speak on their experiences in leading major social justice movements in the U.S. The first of these powerful women is Alicia Garza, a co-founder of the Black Lives Matter Movement. During her talk, Garza reflected on her experiences that led to Black Lives Matter, and I was moved by her strength, eloquence, and wisdom. It’s important to note that Black Lives Matter is a movement that was started by three Women of Color, and one that fights for all Black people, including women, queer and transgender people, poor people and immigrants. The second speaker is the amazing Loretta Ross, a professor at Hampshire College and co-founder of the SisterSong Women of Color Reproductive Justice Collective. Reproductive Justice is a movement also founded by Women of Color, and one that merges reproductive rights and social justice within a human rights framework.

Loretta Ross, a co-founder and former national coordinator for SisterSong Women of Color Reproductive Justice Collective, in Augusta last month.

Both leaders centered feminism and intersectionality, and what these concepts mean to them, in their discussions. Garza commented on our need to redefine feminism to better address intersectionality, as feminism is not about just one issue. Looking through an intersectional lens means recognizing that we all have many aspects to our identity: our race, sexuality, gender, and socioeconomic class. It also means analyzing how these aspects intertwine, and how we may experience power and privilege in some ways, while experiencing powerlessness in others. A lot of what Garza said about intersectional feminism strongly resonated with me. I believe, both as a future social worker and as an individual, that you cannot look at one aspect of a person’s identity and expect to understand the bigger picture. When Garza described intersectional feminism as “transformative” and the “feminism that could free us all,” I was very much on board. Loretta Ross brought another perspective to the table. Ross prefers the term “justice feminism,” adding that “intersectionality is a process, human rights are the goal.” Ross calling herself a justice feminist reflects her feminist goals, while practicing intersectional feminist analysis better describes the process.

Garza and Ross are two powerful women in the fight for racial and reproductive justice. However, while they share some common goals, the process or paths they take may differ due to many factors, including being from two different generations, growing up in different areas, and, of course, being two different people with unique experiences. I felt that Ross touched on this well when she said, “If I only worked with people whose minds worked just like mine, I’d have a movement of one.” As a social work student, I’ve had discussions with my classmates on our tendencies to assume the people around us think exactly as we do. In reality, while we may have common goals surrounding justice and social growth, we may also see different paths to these ideas. A strong point to take away from Ross’s discussion is not to debate what “type” of feminism or advocacy is the best, as the energy spent doing so only takes away from the goal, whether your goal is getting certain policy passed, or changing the dialogue around a social issue. As Ross put it, “calling each other out on not being ‘woke’ enough is not helpful.” She discussed our need to change the dynamic from “calling out” to “calling in.”

It’s easy to write someone off because they are not on the same page, or they said something wrong, or because they come from very different experiences. However, when we’re put in a situation where we can “call in,” we may be surprised by the change we are able to make. This fall, as part of my internship, I participated in outreach work with the Mainers for Healthcare Campaign. When I started, my supervisor and MFP’s Community Organizer, Cait Vaughan, went through a canvassing training with me. Cait explained that while many interactions will be positive, that might not always be the case. She then gave me a piece of advice that really stuck with me, which is that people may say things that feel like they’re coming from a place of anger, when they may actually be coming from a place of fear, or having misinformation. It’s easy to react to anger with anger, but if we are able to stop and ask questions instead, we are also then able to meet the person where they are in how they are honestly feeling. Weeks and several canvassing shifts later, I have had a few of these interactions with folks where someone made a cringe-worthy comment, and while it was difficult not to feel upset, I did my best to engage with them and ask questions.

With all of this said, I feel it is also important to note that we are not always able, nor are we ever obligated, to “call in.” While I agree with the notion of leaning in and asking questions when we are able, call-in culture should not come at the expense of sacrificing one’s values. We should always leave room to allow ourselves to draw a line and exit a conversation if someone really is coming from a place of anger, hate, or aggression.

Being able to attend the Maine Women’s Summit on Economic Security and experience Alicia Garza and Loretta Ross’ talks was an amazing and inspiring opportunity. Seeing so many strong women from Maine, the country, and the world was a wonderful experience to take away from my field placement with Maine Family Planning. It gives me hope for my community and excitement to go out and work with some of these amazing people in my career.

Any day now, we expect the Trump administration to issue its Title X Funding Opportunity Announcement (FOA)—and to be honest, we’re a little nervous.

After all, the Department of Health and Human Services (HHS) political appointee overseeing the Title X program, Deputy Assistant Secretary for Population Affairs Teresa Manning, has publicly opposed the use of federal funds for family planning and stated that contraception is ineffective. The former anti-abortion lobbyist also opposes emergency contraception. What’s more, a memo leaked last month suggested that advisers to the Trump administration are seeking to slash Title X funding by half—and/or to promote the “fertility awareness” method of birth control in place of other, more effective forms of contraception.

The National Family Planning & Reproductive Health Association, of which we are a member, sees the likelihood of an attack on Title X as “High;” the Guttmacher Institute said in October: “Never in its history has the nation’s family planning safety net been in such jeopardy as it is today.”

You can see why we’re not exactly optimistic.

There are a few ways HHS could go after family planning providers through Title X:

By cutting or eliminating Title X funding altogether;

By altering the parameters of the grant to include so-called “crisis pregnancy centers” (which use tactics of misinformation and deception to prevent women from accessing abortion care) as eligible entities or “tiering” providers (giving preference to public health departments or primary care providers in order to shut out non-profit organizations like MFP);

By putting onerous conditions on Title X recipients—and their patients—such as requiring parental notification and consent for teens seeking contraceptive care, a policy repeatedly rejected by the Maine Legislature;

By instituting what’s known as the Domestic Gag Rule, which would bar Title X-funded health care providers from talking about abortion as one of three choices available to pregnant patients who come to us for comprehensive options counseling.

Under any of the above scenarios, the Maine Family Planning network of providers (18 MFP clinics, plus four Planned Parenthood sites, 20 Federally-Qualified Health Centers, and five school-based health centers) would be hamstrung in its ability to provide a full range of contraceptive and reproductive health care services to low-income, uninsured, and underinsured women, men, and teens around the state.

We are staying vigilant as the right wing’s latest attack on women’s health care looms. Stay tuned.

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